Burns and Electric Shock

Topic Overview

Most burns are minor injuries that occur at
home or work. It is common to get a minor burn from hot water, a curling iron,
or touching a hot stove. Home treatment is usually all that is needed for
healing and to prevent other problems, such as infection.

There are
many types of burns.

Heat burns (thermal burns)
are caused by fire, steam, hot objects, or hot liquids. Scald burns from hot
liquids are the most common burns to children and older
adults.

Electrical burns are caused by
contact with electrical sources or by lightning.

Chemical burns are caused by contact with household or
industrial chemicals in a liquid, solid, or gas form. Natural foods such as
chili peppers, which contain a substance irritating to
the skin, can cause a burning sensation.

Friction burns are caused by contact with any hard surface such as roads ("road
rash"), carpets, or gym floor surfaces. They are usually both a scrape
(abrasion) and a heat burn. Athletes who fall on floors, courts, or tracks may get friction burns to the skin. Motorcycle or bicycle riders who have road
accidents while not wearing protective clothing also may get friction burns. For
information on treatment for friction burns, see the topic
Scrapes.

Burns injure the skin layers and can also injure other parts of the body, such
as muscles, blood vessels, nerves, lungs, and eyes. Burns are defined as
first-, second-, third-, or fourth-degree, depending on how many
layers of skin and tissue are burned. The deeper the burn and the larger the
burned area, the more serious the burn is.

Burns affect people of all ages, though some are at higher
risk than others.

Most burns that occur in children younger than
age 5 are scald burns from hot liquids.

Over half of all burns
occur in the 18- to 64-year-old age group.

Older adults are at a
higher risk for burns, mostly scald burns from hot liquids.

Men
are twice as likely to have burn injuries as women.

Burns in children

Babies and young children may have
a more severe reaction from a burn than an adult. A burn in an adult may cause
a minor loss of fluids from the body, but in a baby or young child, the same
size and depth of a burn may cause a severe fluid loss.

A child's
age determines how safe his or her environment needs to be, as well as how much
the child needs to be supervised. At each stage of a child's life, look for
burn hazards and use appropriate
safety measures. Since most burns happen in the home,
simple safety measures decrease the chance of
anyone getting burned. See the Prevention section of this topic.

When a child or
vulnerable adult is burned, it is important to find
out how the burn happened. If the reported cause of the burn does not match how
the burn looks,
abuse must be considered and resources for help, such as social services, offered. Self-inflicted burns will
require treatment as well as an evaluation of the person's emotional
health.

Infection is a concern with all burns. Watch for
signs of infection during the healing process. Home
treatment for a minor burn will reduce the risk of infection. Deep burns with
open blisters are more likely to become infected and need medical
treatment.

You may need a tetanus shot depending
on how dirty the wound is and how long it has been since your last shot.

For a dirty wound that has
things like dirt, saliva, or feces in it, you may need a shot if:

You haven't had a tetanus shot in the past 5
years.

You don't know when your last shot was.

For a clean wound, you may
need a shot if:

You have not had a tetanus shot in the past 10
years.

You don't know when your last shot was.

To clean a wound well:

Wash your hands first.

Remove large
pieces of dirt or debris from the wound with cleaned tweezers. Do not push the
tweezers deeply into the wound.

Hold the wound under cool running
water. If you have a sprayer in your sink, you can use it to help remove dirt
and other debris from the wound.

Scrub gently with water, a mild
soap, and a washcloth.

If some dirt or other debris is still in
the wound, clean it again.

If the wound starts to bleed, put
direct, steady pressure on it.

If a chemical has caused a wound or burn, follow the instructions on the chemical's container or call Poison Control (1-800-222-1222) to find out what to do. Most chemicals should be rinsed off with lots of water, but with some chemicals, water may make the burn worse.

Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.

Symptoms of shock in a child may include:

Passing out.

Being very sleepy or hard
to wake up.

Not responding when being touched or talked to.

Breathing much faster than usual.

Acting confused.
The child may not know where he or she is.

Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

Passing out.

Feeling very dizzy or
lightheaded, like you may pass out.

Feeling very weak or having
trouble standing.

Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.

Symptoms of infection may
include:

Increased pain, swelling, warmth, or redness in or
around the area.

Red streaks leading from the area.

Pus draining from the area.

A fever.

Here are some ways to estimate how much of the body is burned in a baby or young child.

The palm of the child's hand equals 1% of the
body's surface area. Using the child's palm is a good way to estimate the size
of a small burn.

The total surface of the head plus the neck is 21%
of the body's surface area.

The total surface of one arm and hand
is 10%.

The total surface of the chest plus the belly is
13%.

The back is 13%.

The buttocks are
5%.

The total surface of one leg and foot is 13.5%.

The
groin area is 1%.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.

Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.

Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.

Pain in adults and older children

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Heartbeat changes can include:

A faster or slower heartbeat than is normal for
you. This would include a pulse rate of more than 120 beats per minute (when
you are not exercising) or less than 50 beats per minute (unless that is normal
for you).

A heart rate that does not have a steady
pattern.

Skipped beats.

Extra beats.

Severe trouble breathing means:

You cannot talk at all.

You have to
work very hard to breathe.

You feel like you can't get enough
air.

You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It's hard to talk in full
sentences.

It's hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.

It's becoming hard to breathe with activity.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

Try home treatment to relieve the
symptoms.

Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.

Some common burn patterns and common areas for
burns that result from abuse include:

Circular burns that are the size and shape of the
end of a cigarette or cigar.

Burns on the bottom of the
feet.

Burns that look like gloves (on the hands), socks (on the
feet), or a large circle on the buttocks. These come from putting someone's
hands, feet, or buttocks in a sink or tub of scalding-hot water.

With burns caused by abuse, the explanation for the burn may not
match the size, shape, or location of the burn. But it still can be hard to
tell whether a burn was caused on purpose. A burn caused by throwing hot liquid
on someone may look just like a burn caused by an accidental spill.

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

Your age. Babies and older
adults tend to get sicker quicker.

Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
disease, you may need to pay closer attention to certain symptoms and seek care
sooner.

Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
worse.

Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
more serious.

Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.

It can be hard to tell how deep a burn is.

A fourth-degree burn goes
through the skin and fatty tissue to injure muscle, nerves, blood vessels, and
bones.

A third-degree burn goes through all
the skin layers to the fatty tissue beneath. The skin is dry and swollen and
may be pale white or charred black. This kind of burn destroys the nerves, so
it may not hurt except on the edges.

A second-degree burn involves several layers of skin. The skin
may be swollen, puffy, moist, or blistered.

A first-degree burn affects only the outer layer of skin. The
skin is dry and hurts when you touch it. A mild sunburn is a first-degree burn.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).

It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Severe trouble breathing means:

The child cannot eat or talk because he or she is
breathing so hard.

The child's nostrils are flaring and the belly
is moving in and out with every breath.

The child seems to be
tiring out.

The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than
usual.

The child has to take breaks from eating or talking to
breathe.

The nostrils flare or the belly moves in and out at times
when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.

The child seems a little out of breath but can still eat or talk.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and
illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease,
and HIV/AIDS.

Long-term alcohol and drug
problems.

Steroid medicines, which may be used to treat a variety
of conditions.

Chemotherapy and radiation therapy for
cancer.

Other medicines used to treat autoimmune
disease.

Medicines taken after organ transplant.

Not
having a spleen.

Here are some ways to estimate how much of the body is burned in an adult or older child.

The palm of the person's hand equals 1% of the
body's surface area. Using the person's palm is a good way to estimate the size
of a small burn.

The total surface of the head plus the neck is 9%
of the body's surface area.

The total surface of one arm and hand
is 9%.

The chest is 9%.

The belly is 9%.

The upper back is 9%.

The lower back is
9%.

The total surface of one leg and foot is 18%.

The
groin area is 1%.

Home Treatment

Most minor burns will heal on
their own, and home treatment is usually all that is needed to relieve your
symptoms and promote healing. But if you suspect you may have a more severe
injury, use first-aid measures while you arrange for an evaluation by your
doctor.

Immediate first aid for burns

First, stop the burning to prevent a more
severe burn.

Heat burns (thermal burns): Smother any
flames by covering them with a blanket or water. If your clothing catches fire,
do not run: stop, drop, and roll on the ground to
smother the flames.

Cold temperature burns: Try first aid measures to warm the areas. Small areas of your body (ears, face, nose, fingers, toes) that are really cold or frozen can be warmed by blowing warm air on them, tucking them inside your clothing or putting them in warm water.

Liquid scald burns (thermal burns): Run cool
tap water over the burn for 10 to 20 minutes. Do not use ice.

Electrical burns: After the person has been separated
from the electrical source, check for breathing and a heartbeat. If the person
is not breathing or does not have a heartbeat, call 911.

Chemical burns: Natural foods such as
chili peppers, which contain a substance irritating to
the skin, can cause a burning sensation. When a chemical burn occurs, find out
what chemical caused the burn. Call your local Poison Control Center or the National Poison Control Hotline (1-800-222-1222) for more information about how to treat the burn.

Remove any jewelry or clothing
at the site of the burn. If clothing is stuck to the burn, do not remove it.
Carefully cut around the stuck fabric to remove loose fabric. Remove all
jewelry, because it may be hard to remove it later if swelling
occurs.

Prepare for an evaluation by a doctor

If you are
going to see your doctor soon:

Cover the burn with a clean, dry cloth to
reduce the risk of infection.

Do not put any salve or medicine on
the burned area, so your doctor can properly assess your burn.

Do
not put ice or butter on the burned area, because these measures do not help
and can damage the skin tissue.

Home treatment for minor burns

Apply
soothing lotions that contain aloe vera to burned areas to relieve pain and
swelling. Applying
0.5% hydrocortisone cream to the burned area also may
help. Note: Do not use the cream on children younger
than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal
area of children younger than age 12 unless your doctor tells you to.

There isn't much you can do to stop skin from
peeling after a sunburn—it is part of the healing process. Lotion may help
relieve the itching.

Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin

Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow
these safety tips when you use a nonprescription medicine:

Carefully read and follow all
directions on the medicine bottle and box.

Lotions

Some doctors suggest using skin lotions,
such as Vaseline Intensive Care or Lubriderm, on first-degree burns or
second-degree burns that have unbroken healing skin. These skin lotions can be
used to relieve itching but should not be used if the burns have fluid weeping
from them or have fresh scabs. An antihistamine, such as Benadryl or
Chlor-Trimeton, can also help stop the itching. Read and follow any warning on
the label.

When a first-degree burn or minor second-degree burn is
2 to 3 days old, using the juice from an aloe leaf can help the burn heal and
feel better. Applying the aloe juice may sting at first contact.

It is important to protect a burn while it is healing.

Newly healed burns can be sensitive to
temperature. Healing burns need to be protected from the cold, because the
burned area is more likely to develop frostbite.

A newly burned
area can sunburn easily. Sunscreen with a high sun protective factor (SPF at
least 30) should be used for the first year after a burn to protect the new
skin.

Do not smoke. Smoking slows healing because it decreases blood
supply and delays tissue repair. For more information, see the topic
Quitting Smoking.

Symptoms to watch for during home treatment

Prevention

Most burns happen in the home. Simple
safety measures decrease the chances
of anyone getting burned.

Home safety measures

Do not smoke in bed.

Place smoke
alarms and other fire safety devices in strategic locations in your home, such
as in the kitchen and bedrooms and near fireplaces or stoves. Smoke detectors
need to be checked and to have the batteries replaced regularly. A good way to
remember to do this is to check smoke detectors twice a year when daylight
savings and standard time change.

Make a fire escape plan, and make
sure the family knows it (babysitters, too).

Keep a fire
extinguisher near the kitchen and have it checked yearly. Learn how to use it.
Put out food or grease fires in a pan with a lid or another
pot.

Set your water heater at
120°F (50°C) or lower. Always
test the temperature of bathwater.

Store cleaning
solutions and paints in containers in well-ventilated areas.

Use
proper fuses in electrical boxes, do not overload outlets, and use insulated
and grounded electrical cords.

Keep trash cleaned up in attics,
basements, and garages.

Be careful with gas equipment such as lawn
mowers, snowblowers, and chain saws.

Be careful with any flammable substances used to start fires, such as lighter fluid.

Avoid fireworks. Think of
safety first when dealing with fireworks.

Your local fire department is a good resource for more
information on how to prevent fires, make a fire escape plan, use fire safety
devices, and provide first-aid treatment for burns.

Keep matches and flames, such as candles or
lanterns, out of the reach of children. Keep small children away from stoves
and ovens when you are cooking, and do not place pot handles where a child can
reach them. Do not let children play with any small appliances such as curling
irons, hair dryers, toasters, or heating pads.

Never hold a child
while smoking or drinking a hot liquid, because any sudden movement by the
child could cause a burn.

Never leave hot
foods or liquids within reach of children, such as on the edges of tables or
counters. Also, be cautious about leaving hot liquids on a table with a
tablecloth that young children can reach and pull down.

Keep
electrical cords away from a child's reach. A child chewing on a cord could
cause an electrical burn of the mouth. Cover electrical outlets so children
will not stick items in the outlet.

Do not allow children to remove
hot items from the oven or microwave. Use caution whenever heating baby bottles
in the microwave so that the liquid does not get too hot. A liner may burst or
a lid may not be secure, and when the bottle is tipped for feeding, the hot
contents may burn the baby. For this reason, most doctors recommend that
bottles not be heated in the microwave.

Store cleaning solutions and chemicals out of the reach
of children.

Friction burns can cause small cuts and scrapes. Don't pull or drag your child across carpet while playing.

Teach children who are old
enough to understand to stop, drop, and roll if their
clothing catches on fire so they can help put out the flame and prevent getting
burned more.

Buy children's sleepwear made of flame-retardant
fabric. Dress children in flame- and fire-retardant clothing. Older adults need
to be careful about wearing clothing with loose material that could catch on
fire.

Keep woodstoves and fireplaces in good working condition, and
use screens to keep children a safe distance away. Keep portable heaters,
furnaces, water heaters, and small appliances in good working
condition.

Reduce the risk of a lightning strike

In general,
avoid placing camping tents under tall trees, near bodies of water, or on the
highest hill in an area. Seek shelter in a covered area, such as a car, if you
get caught outdoors in bad weather. If no shelter is available, lie on the
ground in a ditch or take cover in a thick grove of trees, where lightning
striking a single tree is unlikely.

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